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Hearing Tests

Test Overview

A hearing (audiometric) test is part of an ear exam that tests how well a person is able to hear. It is done by measuring how well sound can reach the brain.

The sounds we hear start as
vibrations in the air around us. The
vibrations make sound waves, which vibrate at a certain speed (frequency)
and have a certain height (amplitude). The vibration speed of a sound wave
determines how high or low a sound is (pitch). The height of the sound wave
determines how loud the sound is (volume).

Hearing happens when
these sound waves travel through the ear and are turned into nerve impulses.
These nerve impulses are sent to the brain, which "hears" them.

Sound waves enter the
ear through the ear canal (external ear). Then they strike
the eardrum (tympanic membrane). The eardrum separates the ear canal and the middle
ear.

The eardrum vibrates, and the vibrations move to the bones of
the middle ear. In response, the bones of the middle ear vibrate, which boosts
the sound and sends it to the inner ear.

The fluid-filled,
curved space of the inner ear, sometimes called the labyrinth, contains the
main sensory organ of hearing. This organ is called the cochlea. Sound vibrations cause the fluid in
the inner ear to move, which bends tiny hair cells (cilia) in the cochlea. The
movement of the hair cells creates nerve impulses. These nerve impulses then travel along the
cochlear nerve to the brain and are read as sound.

Hearing tests help find what kind of
hearing loss you have. The tests measure how well you can
hear sounds that reach the inner ear through the ear canal. They also measure sounds that are spread through the skull.

Most hearing tests ask you to respond to a series of tones or
words. But there are some hearing tests that do not require a response.

Why It Is Done

Hearing tests may be done:

To check, or screen, babies and young children for hearing
problems that might affect their ability to learn, speak, or understand
language. The
U.S. Preventive Services Task Force
suggests that all newborns be screened for hearing loss.footnote 1 All 50 states require newborn hearing tests for all babies
born in hospitals. Also, many health groups and doctors' groups
suggest routine screening. Talk to your doctor about whether your child has
been or should be tested.

To screen children and teens for
hearing loss. Hearing should be checked by a doctor at each
well-child visit. In children, normal hearing is
important for proper language development. Some speech, behavior, and learning
problems in children can be related to problems with hearing. For this reason,
many schools provide hearing tests when children first begin school.
The American Academy of Pediatrics suggests a formal hearing test at ages 4,
5, 6, 8, and 10 years. footnote 2

To test for possible
hearing loss in anyone who has noticed an ongoing hearing problem in one or
both ears or has had a hard time understanding words in
conversation.

To screen for hearing problems in older adults.
Hearing loss in older adults is often mistaken for a reduced mental ability. (For example, a person may seem to not listen or respond to
conversation.)

To screen for hearing loss in people who are
often exposed to loud noises or who take certain antibiotics, such
as gentamicin.

To find out the type and amount of hearing loss
(conductive, sensorineural, or both). In conductive hearing loss, the movement
of sound (conduction) is blocked or does not pass into the inner ear. In
sensorineural hearing loss, sound reaches the inner ear, but a problem in the
nerves of the ear or, in rare cases, the brain itself prevents proper
hearing.

How To Prepare

Tell your doctor if:

You have recently been exposed to any painfully
loud noise or to a noise that made your ears ring. Avoid loud noises for 16
hours before you have a thorough hearing test.

You take or have
taken antibiotics that can damage hearing, such as gentamicin.

You have
had any problems hearing normal conversations or have noticed any other signs of
possible hearing loss.

You have recently had a cold or an ear
infection.

Before you start any hearing tests, your ear canals may be checked for earwax. This can affect how well you can hear the tones or words during testing. Hardened wax may be removed.

You may wear headphones for some tests. You will need to remove
eyeglasses, earrings, or hair clips that can affect the placement of the
headphones. The person giving the test will press on each ear to find out if
the pressure from the headphones on your outer ear will cause the ear canal to
close. If so, a thin plastic tube may be placed in the ear canal before the
testing to keep your ear canal open. The headphones are then placed on your
head and adjusted to fit.

If you wear hearing aids, you
may be asked to remove them for some of the tests. You may be asked to shampoo
your hair before you have auditory brain stem response (ABR) testing.

Talk to your doctor about any concerns you have about the need for a
hearing test, its risks, how it will be done, or what the results will mean. To
help you understand the importance of this test, fill out the
medical test information form(What is a PDF document?).

How It Is Done

Hearing tests can be done in an
audiometry (hearing) lab by a hearing specialist (audiologist). They can also be done in a doctor's office, a school, or the workplace by a nurse, a health
professional, a psychologist, a speech therapist, or an audiometric technician.

Whispered speech test

In a whispered speech test,
the health professional will ask you to cover the opening of one ear with your
finger. He or she will stand
1 ft (0.3 m) to
2 ft (0.6 m) behind you and
whisper a series of words. You will repeat the words that you hear. If you
can't hear the words at a soft whisper, the health professional will say the words more loudly until you can hear them. Each ear is tested
separately.

Pure tone audiometry

Pure tone audiometry uses a
machine called an audiometer to play a series of tones through headphones. The
tones vary in pitch (frequency, measured in hertz) and loudness (intensity,
measured in decibels). The person doing the test will control the volume of a
tone. He or she will reduce its loudness until you can no longer hear it. Then the tone
will get louder until you can hear it again. You signal by raising your hand or
pressing a button every time you hear a tone, even if the tone you hear is very
faint. The person will then repeat the test several times, using a
higher-pitched tone each time. Each ear is tested separately. The headphones
will then be removed. A special vibrating device will be placed on the bone
behind your ear. Again, you will signal each time you hear a tone.

Tuning fork tests

A tuning fork is a metal,
two-pronged device that makes a tone when it vibrates. The person giving the test hits the tuning fork to make it vibrate and produce a tone.
These tests check how well sound moves through your ear. Sometimes the tuning
fork will be placed on your head or behind your ear. Depending on how you hear
the sound, the person giving the test can tell if there is a problem with the
nerves or with sound getting to the nerves.

Speech reception and word recognition tests

Speech
reception and word recognition tests measure how well you can hear and
understand normal speech. In these tests, you are asked to repeat a
series of simple words spoken at different volumes. A test called
the spondee threshold test finds the level at which you can repeat at
least half of a list of familiar two-syllable words.

Otoacoustic emissions (OAE) testing

Otoacoustic
emissions (OAE) testing is often used to check newborns for hearing problems.
In this test, a small, soft microphone is placed in the baby's ear canal. Sound
is then sent through a small flexible probe that has been put in the baby's ear.
The microphone detects the inner ear's response to the sound. This test
can't tell the difference between conductive and sensorineural hearing loss.

Auditory brain stem response (ABR) testing

Auditory brain stem response (ABR) testing checks for sensorineural hearing
loss. In this test, electrodes are placed on your scalp and on each earlobe.
Clicking noises are then sent through earphones. The electrodes track your
brain's response to the clicking noises and record the response on a graph.
This test is also called brain stem auditory evoked response (BAER) testing or
auditory brain stem evoked potential (ABEP) testing.

How It Feels

It is not painful to have a hearing test.

Risks

Having a hearing test does not cause problems.

Results

A hearing test is part of an ear
exam that tests how well a person can hear.

Hearing test results

Normal

You are able to hear whispered speech
correctly.

You can hear tones at equal loudness in both
ears.

You are able to repeat 90% to 95% of the words in a word
recognition test.

The microphone finds emissions from the inner
ear in otoacoustic emissions testing.

The values recorded on
the graph for auditory brain stem response testing show that the nerves
in the brain that help with hearing are working as they should.

Abnormal

You are not able to hear the whispers
during a whispered speech test. Or you are able to hear with one ear but not
with the other ear.

You hear the tone more loudly in one ear than in
the other ear.

You can only hear certain sounds at high decibel
levels.

You can hear sounds, but you can't understand
words.

No emissions are found from the inner ear in otoacoustic
emissions testing.

The values recorded on the graph for
auditory brain stem response testing show that the nerves in the brain
that help with hearing are not working as they should.

Sound is described in terms of
frequency and intensity. Your hearing threshold is how loud the sound of a
certain frequency must be for you to hear it.

Whether a sound is low or
high is measured in vibrations per second, or hertz (Hz). This is called frequency, or pitch. The human ear can
normally hear frequencies from a very low rumble of 16 Hz to a high-pitched
whine of 20,000 Hz. The frequencies of normal speech in a quiet place
are 500 Hz to 2,000 Hz.

Intensity, or loudness, is measured in
decibels (dB). The normal range (threshold or lower limit) of hearing is 0 dB to
25 dB. For children, the normal range is 0 dB to 15 dB. Normal results show that
you hear within these ranges in both ears.

The following table relates how loud a sound must be for a
person to hear it (hearing thresholds) to the degree of hearing loss for
adults:

Hearing loss table

Hearing threshold in
decibels (dB)

Degree of hearing
loss

Ability to hear
speech

0-25 dB

None

No significant
trouble hearing.

26-40 dB

Mild

Trouble with faint or
distant speech.

41-55 dB

Moderate

Trouble with conversational
speech.

56-70 dB

Moderate to
severe

Speech must be loud;
trouble with group conversation.

71-90 dB

Severe

Trouble with loud speech. Understands only shouted or amplified speech.

91+ dB

Profound

May not understand amplified
speech.

What Affects the Test

You may not be able to have the test, or the results may not be helpful, if:

You are not able to follow directions
or understand speech well enough to respond during most tests. It may be
hard to do hearing tests on young children or on people who have
physical or mental disabilities.

There is background noise or equipment problems, such as
cracked or poorly fitting headphones or an uncalibrated audiometer.

You have a hard time speaking or understanding the language
of the tester.

You have had a recent cold or ear infection.

You have been
around loud noises within 16 hours before the test.

What To Think About

Other types of tests may be used to check
hearing. These tests include:

Acoustic immittance testing. This 2- to 3-minute test measures how well
the eardrum moves in response to sound. The soft tip of a small tool is put into the ear canal and adjusted to make a tight seal. Sound and air pressure
are then sent toward the eardrum. The test is not painful. But you may feel slight
changes in pressure or may hear the tone.

Vestibular tests. These
tests look for problems with areas of the inner ear that help control balance
and coordination. During these tests, you try to maintain balance and
coordination while being asked to move in many different ways, with your eyes open
and closed. The person giving the test will make sure that you do not fall.
You don't need to do anything to prepare for these tests.

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